Atrovent for Pediatrics

[Melbourne MICA]

And it is. But what is necessary for an urban service with short transports and a variety of tertiary care centers may not be the same for a rural service with long transports and no other resources. No sense in including things that are not necessary.

But very much of medicine doesn't have the advantage of clear evidence as to what the best practice should be. This very topic is a perfect example - I'm not sure atrovent has ever been shown to really improve outcomes in most cases of asthma. At least not that giving it in the field is any better than giving it in the ED. So some medical directors want their crews to use it because they feel it helps, and other docs don't bother putting it in the protocols. The fact that its use in peds is off-label just adds another reason to perhaps leave it out of the protocols, especially if your agency has very short transport times.

Some medical directors like midazolam for seizures; others choose lorazepam. Some prefer ketamine over etomidate. Some want fentanyl given before RSI, others don't. Some want most meds given IM if an IV can't be established, others want an IO placed. No firm body of evidence supporting any of these choices, so the protocols reflect the preferences of the MD's writing them.

These things could all be standardized by a committee in DC writing a set of national ALS protocols, but there'd be individual medical directors all over the country who strongly disagreed with certain parts of the protocols.

Agree with all the points except the very reason there are state based guidelines is to overcome the pitfalls of a thousand different protocols depending on what side of the county line you are on. State based guidelines are supposed to (emphasis on supposed to) derive from a consensus judgement of all the stakeholders and utilise an evidence assessment. I'm also channeling my own investigations into the burn first aid situation where there is, basically, no single jurisdiction that does the same thing as another - anywhere in the western world!! And yet a burn is a burn is a burn no matter where you are. Into this mix of local fiefdoms has come the commercial sector out for profit. This has happened with hydrogels. But it doesn't have to be that way. Its just one example but our own organisation brought them in. Then I was asked to do proper research on them exploring the evidence base. The end result is our own CPG's were changed drastically (we dumped them) and even ANZBA changed theirs as well because I presented the findings of my research at a conference - The ANZBA international burns conference in 2011. (Also partly out of embarrassment because they put out a position statement in 2006 supporting hydrogels) that clearly did not look properly at the evidence). Anyway, enough of my whining.

MM

 

[harold1981]

In the whole of the Netherlands we use albuterol/atrovent for all pedi patients in case of an astma attack.
Younger than 4 years: 2,5mg / 0,5mg (standard adult dose)
4 to 18 years: 5mg / 1 mg (which is double the standard dose of an adult patient), this dose may be repeated once should the patient condition not improve.
Solumedrol follows, in a dosis of 25, 50 or 100 mg IV or IM, depending on the age.

 

[Aprz]

I was looking through some notes I saved. Found this and thought of this thread. It's about magnesium vs atrovent in treating asthma.

This meta-analysis reviewed 40 identified trials, 13 were relevant and eight of these were of high quality. The conclusion of the authors is, “A single dose of an anticholinergic agent is not effective for the treatment of mild and moderate exacerbations and is insufficient for the treatment of severe exacerbations. Adding multiple doses of anticholinergics to beta2 agonists appears safe, improves lung function and would avoid hospital admission in 1 of 12 such treated patients. Although multiple doses should be preferred to single doses of anticholinergics, the available evidence only supports their use in school-aged children with severe asthma exacerbation. There is no conclusive evidence for using multiple doses of anticholinergics in children with mild or moderate exacerbations.”
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000060/abstract

https://www.facebook.com/permalink.php?story_fbid=596093183735016&id=287131411297863

 

[Doczilla]

It probably helped because kids are so prone to excess vagal tone; as atrovent only reverses vagally-mediated Bronchospasm.